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Rajan S, Patel N, Stechman M, Balasubramanian SP, Mihai R, Aspinall S. Impact of adrenal surgeon volume on outcome: analysis of 4464 operations from the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS). Br J Surg 2024; 111:znae002. [PMID: 38306505 DOI: 10.1093/bjs/znae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND There is a surgeon volume-outcome effect in adrenal surgery but the threshold for high-volume surgeon remains controversial. This study aimed to determine predictors of high-risk adrenal operations and to explore whether these should be restricted to high-volume surgeons. METHODS Patients undergoing adrenal surgery and registered in the United Kingdom Registry of Endocrine and Thyroid Surgery between 2004 and 2021 were analysed. Outcomes included postoperative complications, duration of hospital stay, and mortality. Factors included in multivariable analysis were age, sex, diagnosis, surgical approach, laterality, and surgeon volume. Patients with missing data were excluded. RESULTS A total of 4464 of 6174 patients (72.3%) were analysed. Postoperative complications occurred in 418 patients (9.4%) and 14 (0.3%) died. Median duration of hospital stay was 3 (i.q.r. 2-5) days. Co-variables significantly associated with an increase or decrease in postoperative complications (P < 0.050) were age (OR 1.02, 95% c.i. 1.01 to 1.03), adrenal cancer (OR 1.64, 1.14 to 2.36), minimally invasive approach (OR 0.317, 0.248 to 0.405), bilateral surgery (OR 1.66, 1.03 to 2.69), and surgeon volume (OR 0.98, 0.96 to 0.99). An increase or decrease in mortality was associated with patient age (OR 1.08, 1.03 to 1.13), minimally invasive approach (OR 0.08, 0.02 to 0.27), and bilateral surgery (OR 6.93, 1.40 to 34.34). The incidence of postoperative complications was significantly lower above a threshold of 12 operations per year (P = 0.034) and 20 per year (P < 0.001), but not six per year (P = 0.540). Median duration of hospital stay was 2 days for surgeons doing over 20 operations per year, compared with 3 days for those undertaking fewer than 20, fewer than 12 or fewer than 6 operations per year. CONCLUSION Increasing surgical volume is associated with shorter hospital stay and fewer complications. This analysis supports the case for centralization of surgery for adrenal cancer and bilateral tumours to higher-volume surgeons performing a minimum of 12 operations per year.
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Affiliation(s)
- Sendhil Rajan
- Breast and Endocrine Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Neil Patel
- Endocrine Surgery, University Hospital of Wales, Cardiff, UK
| | | | | | - Radu Mihai
- Endocrine Surgery, Churchill Cancer Centre, Oxford, UK
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2
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Parente A, Kamarajah SK, Thompson JP, Crook C, Aspinall S, Melvin R, Stechman MJ, Perry H, Balasubramanian SP, Pannu A, Palazzo FF, Van Den Heede K, Eatock F, Anderson H, Doran H, Wang K, Hubbard J, Aldrees A, Shore SL, Fung C, Waghorn A, Ayuk J, Bennett D, Sutcliffe RP. Risk factors for postoperative complications after adrenalectomy for phaeochromocytoma: multicentre cohort study. BJS Open 2023; 7:zrad090. [PMID: 37757753 PMCID: PMC10533033 DOI: 10.1093/bjsopen/zrad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/13/2023] [Accepted: 07/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND To determine the incidence and risk factors for postoperative complications and prolonged hospital stay after adrenalectomy for phaeochromocytoma. METHODS Demographics, perioperative outcomes and complications were evaluated for consecutive patients who underwent adrenalectomy for phaeochromocytoma from 2012 to 2020 in nine high-volume UK centres. Odds ratios were calculated using multivariable models. The primary outcome was postoperative complications according to the Clavien---Dindo classification and secondary outcome was duration of hospital stay. RESULTS Data were available for 406 patients (female n = 221, 54.4 per cent). Two patients (0.5 per cent) had perioperative death, whilst 148 complications were recorded in 109 (26.8 per cent) patients. On adjusted analysis, the age-adjusted Charlson Co-morbidity Index ≥3 (OR 8.09, 95 per cent c.i. 2.31 to 29.63, P = 0.001), laparoscopic converted to open (OR 10.34, 95 per cent c.i. 3.24 to 36.23, P <0.001), and open surgery (OR 11.69, 95 per cent c.i. 4.52 to 32.55, P <0.001) were independently associated with postoperative complications. Overall, 97 of 430 (22.5 per cent) had a duration of stay ≥5 days and this was associated with an age-adjusted Charlson Co-morbidity Index ≥3 (OR 4.31, 95 per cent c.i. 1.08 to 18.26, P = 0.042), tumour size (OR 1.15, 95 per cent c.i. 1.05 to 1.28, P = 0.006), laparoscopic converted to open (OR 32.11, 95 per cent c.i. 9.2 to 137.77, P <0.001), and open surgery (OR 28.01, 95 per cent c.i. 10.52 to 83.97, P <0.001). CONCLUSION Adrenalectomy for phaeochromocytoma is associated with a very low mortality rate, whilst postoperative complications are common. Several risk factors, including co-morbidities and operative approach, are independently associated with postoperative complications and/or prolonged hospitalization, and should be considered when counselling patients.
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Affiliation(s)
- Alessandro Parente
- HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sivesh K Kamarajah
- HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Ross Melvin
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Helen Perry
- Department of Endocrine Surgery, University Hospital Wales, Cardiff, UK
| | | | - Arslan Pannu
- Department of General Surgery, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Fausto F Palazzo
- Department of Endocrine Surgery, Hammersmith Hospital, London, UK
| | | | - Fiona Eatock
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Hannah Anderson
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Helen Doran
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | - Kelvin Wang
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | | | | | - Susannah L Shore
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Clare Fung
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Alison Waghorn
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - John Ayuk
- Department of Endocrinology, Queen Elizabeth Hospital, Birmingham, UK
| | - Davinia Bennett
- Department of Anaesthetics, Queen Elizabeth Hospital, Birmingham, UK
| | - Robert P Sutcliffe
- HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Parente A, Thompson JP, Crook C, Bassett P, Aspinall S, Melvin R, Stechman MJ, Perry H, Balasubramanian SP, Pannu A, Palazzo FF, Van Den Heede K, Eatock F, Anderson H, Doran H, Wang K, Hubbard J, Aldrees A, Shore SL, Fung C, Waghorn A, Ayuk J, Bennett D, Sutcliffe RP. Risk factors for postoperative hypotension after adrenalectomy for phaeochromocytoma: derivation of the PACS risk score. Eur J Surg Oncol 2023; 49:497-504. [PMID: 36602554 DOI: 10.1016/j.ejso.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Due to the risk of postoperative hypotension (PH), invasive monitoring is recommended for patients who undergo adrenalectomy for phaeochromocytoma. Due to high costs and limited availability of intensive care, our aim was to identify patients at low risk of PH who may not require invasive monitoring. METHODS Data for patients who underwent adrenalectomy for phaeochromocytoma between 2012 and 2020 were retrospectively collected by nine UK centres, including patient demographics, intraoperative and postoperative haemodynamic parameters. Independent risk factors for PH were analysed and used to develop a clinical risk score. RESULTS PH developed in 118 of 430 (27.4%) patients. On univariable analysis, female sex (p = 0.007), tumour size (p < 0.001), preoperative catecholamine level (p < 0.001), open surgery (p < 0.001) and epidural analgesia (p = 0.006) were identified as risk factors for PH. On multivariable analysis, female sex (OR 1.85, CI95%, 1.09-3.13, p = 0.02), preoperative catecholamine level (OR: 3.11, CI95%, 1.74-5.55, p < 0.001), open surgery (OR: 3.31, CI95%, 1.57-6.97, p = 0.002) and preoperative mean arterial blood pressure (OR: 0.59, CI95%, 0.48-1.02, p = 0.08) were independently associated with PH, and were incorporated into a clinical risk score (AUROC 0.69, C-statistic 0.69). The risk of PH was 25% and 68% in low and high risk patients, respectively. CONCLUSION The derived risk score allows stratification of patients at risk of postoperative hypotension after adrenalectomy for phaeochromocytoma. Postoperatively, low risk patients may be managed on a surgical ward, whilst high risk patients should undergo invasive monitoring.
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Affiliation(s)
| | | | | | | | | | - Ross Melvin
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Helen Perry
- Department of Endocrine Surgery, University Hospital Wales, Cardiff, UK
| | | | - Arslan Pannu
- Department of General Surgery, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Fausto F Palazzo
- Department of Endocrine Surgery, Hammersmith Hospital, London, UK
| | | | - Fiona Eatock
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Hannah Anderson
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Helen Doran
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | - Kelvin Wang
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | | | | | - Susannah L Shore
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Clare Fung
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Alison Waghorn
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - John Ayuk
- Department of Endocrinology, Queen Elizabeth Hospital, Birmingham, UK
| | - Davinia Bennett
- Department of Anaesthetics, Queen Elizabeth Hospital, Birmingham, UK
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Rajan S, Gracie D, Aspinall S. Does Surgeon Volume Impact Morbidity Following Parathyroidectomy? A Study of 16,140 Parathyroidectomies from the UK Registry of Endocrine and Thyroid Surgery (UKRETS) Database. World J Surg 2023; 47:1221-1230. [PMID: 36593341 DOI: 10.1007/s00268-022-06863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Outcomes in endocrine surgery have been shown to improve with surgeon volume. We aimed to study the effect of surgeon volume on morbidity following parathyroidectomy. METHODS UKRETS data from 2004 to 2019 was studied. Parathyroidectomies for primary hyperparathyroidism with complete data were included. Exclusion criteria were age <18 or >80 years; surgeons contributing <10 cases overall; and length of stay >28 days. Multivariable analysis was performed. Primary outcome was persistent hypercalcaemia; secondary outcomes were haemorrhage, length of stay, need for re-admission, post-operative hypocalcaemia, and need for calcium/vitamin D supplements to maintain eucalcaemia at 6 months. RESULTS 153 surgeons undertook mean 22.5 (median 17, range 2-115) parathyroidectomies/year. Persistent hypercalcaemia affected 4.8% (776/16140) overall; 5.7% (71/1242) in surgeons undertaking < 10 cases/year; 5.1% (3339/6617) for 10-30 cases/year; 5.0% (270/5397) for 30-50 cases; and 3.3% (96/2884) for >50 cases/year. High-volume (>50 parathyroidectomies/year) surgeons operated 23.4% (809/3464) of negative localisation cases compared to 16.4% (2074/12676) of positive localisation cases. Persistent hypercalcaemia was almost twice as common in image negative (7.9%) compared to image-positive (4%) cases. Persistent hypercalcaemia was significantly more likely to occur in the low volume (<10 parathyroidectomies/year) group than high volume (>50 parathyroidectomies/year), regardless of image positivity (p = 0.0006). Surgeon volume significantly reduced persistent hypercalcaemia on multivariable analysis (OR = 0.878, 95%CI 0.842-0.914, p < 0.001), along with age, sex, and positive localisation. BNE and re-operation significantly increased persistent hypercalcaemia. Post-operative hypocalcaemia occurred in 3.2% (509/16040) and was reduced with increasing surgeon volume (OR = 0.951, 95%CI 0.910-0.993, p < 0.001). Haemorrhage and length of stay were not significantly associated with surgeon volume. CONCLUSION The incidence of persistent hypercalcaemia, post-operative hypocalcaemia, and persistent hypoparathyroidism decreased with increasing surgeon volume. The relative reduction in persistent hypercalcaemia with surgeon volume was similar in image negative and positive groups, but the absolute reduction was higher in image negative cases. Restricting image negative parathyroidectomy to high-volume surgeons could be considered.
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Affiliation(s)
- Sendhil Rajan
- General and Endocrine Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN, UK
| | - Dale Gracie
- Paediatric Surgery, Royal Hospital of Children and Young People, Edinburgh, UK
| | - Sebastian Aspinall
- General and Endocrine Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN, UK.
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Latar NM, Mahkamova K, Elson J, Karnik I, Sutherland R, Aspinall S, Meeson A. Impact of transforming growth factor beta 1 on normal and thyroid cancer side population cells. Endocrine 2022; 76:359-368. [PMID: 35118633 PMCID: PMC9068642 DOI: 10.1007/s12020-022-02990-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/19/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine the impact of exogenous transforming growth factor beta 1 (TGF-β1) on side population (SP) cells isolated from normal, papillary thyroid cancer and anaplastic thyroid cancer cell lines and from human thyroid tissues. METHODS All cell populations were stained with Hoechst 33342 and analysed using dual wavelength flow cytometry to identify SP cells. This SP assay was used to assess the impact of TGF-β1 treatment and withdrawal of treatment on SP percentages. Semi-quantitative and quantitative PCR were used for molecular analysis of cells pre and post TGF-β1 treatment. RESULTS All cell lines expressed mRNA for both TGFB1 and its receptors, as well as showing variable expression of CDH1 and CDH2, with expressing of CDH1 being highest and CDH2 being lowest in the normal cell line. Exposure to exogenous TGF-β1 resulted in a reduction in mRNA expression of ABCG2 compared to controls which was significant between control and treated cancer cell lines. SP cells were isolated from primary human thyroid tissues, with numbers being significantly higher in papillary thyroid cancers. Exposure to TGF-β1 decreased the SP percentage in both thyroid cancer cell lines and completely abrogated these cells in the primary papillary thyroid cancer cultures. On withdrawal of TGF-β1 the SP phenotype was restored in the cancer cell lines and SP percentages increased to above that of untreated cells. CONCLUSIONS TGF-β1 exposure transiently regulates thyroid cancer SP cells, leading to a reduction in SP percentages, while withdrawal of TGF-β1 results in restoration of the SP phenotype.
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Affiliation(s)
- Nani Md Latar
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- Newcastle University Bioscience Institute, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Kamilla Mahkamova
- Newcastle University Bioscience Institute, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Joanna Elson
- Newcastle University Bioscience Institute, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Isha Karnik
- Newcastle University Bioscience Institute, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Rachel Sutherland
- Newcastle University Bioscience Institute, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Sebastian Aspinall
- Department of General Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB252ZN, UK
| | - Annette Meeson
- Newcastle University Bioscience Institute, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK.
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6
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Rajan S, Bhatt D, Graveling A, McAteer D, Abraham P, Aspinall S. Initial experience with 4DCT: Apt Choice for Parathyroid Localization? Br J Surg 2022. [DOI: 10.1093/bjs/znac056.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Optimal modality for pre-operative radiological parathyroid localization in primary hyperparathyroidism (PHPT) is controversial. Four-dimensional computed tomography (4DCT) is a newer imaging technique that can provide detailed anatomic information. We aimed to evaluate the performance of 4DCT as a localization tool for patients with PHPT.
Methods
Between 03/2018 and 05/2021, 121 patients were operated for primary hyperparathyroidism at our institution. 4DCT was used as a second line investigation in patients <60 years due to concerns about radiation. Electronic patient records including operation notes and pathology were reviewed. 80(66%) had 4DCT for localization.
Results
Mean age of the study population was 68.4 years (Range27–88). Mean tumour size on CT was 16.13mm (range 4–38). Mean serum calcium and PTH levels were 2.89mmol/L and 20.76pmol/L. 4DCT identified a lesion in 61 patients (sensitivity 76.2%) and correctly lateralized a pathological parathyroid in 58/61 patients (specificity 95.1%). Hyperplasia and smaller gland size were non-significantly associated with non-detection (p>0.05). Of the 61 patients with a positive 4DCT, 4 (6.5%) developed persistent disease – in two a lymph node/thyroid nodule was excised and two had multigland disease. In this study 4DCT correctly localized recurrent disease in 4 of 5 patients, and 12 of 15 patients with negative Sestamibi SPECT CT scan.
Discussion
4DCT offers accurate localization of abnormal glands in first-time parathyroidectomy for PHPT. Advantages include simplicity and speed of scan. Using 4DCT for first-time localisation is changing conventional practice of ultrasound+sestamibi scanning. It may have an added role in localizing disease in recurrent HPT and in patients who have a negative nuclear scan.
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Affiliation(s)
- Sendhil Rajan
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Dhruti Bhatt
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
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7
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Cooper D, Aspinall S, Hay A, Adamson R, Nixon I. Audit of the accuracy of the UK Registry of Endocrine and Thyroid Surgery. Br J Surg 2022. [DOI: 10.1093/bjs/znac056.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Clinician-inputted data is collected in the UK Registry of Thyroid Surgery (UKRETS) on endocrine operations performed by members of the British Association of Thyroid Surgeons (BAETS) and analyses of the data published annually in the Surgeon Specific Outcome Reports, National Audit Report and peer reviewed journals. However, UKRETS has never been externally validated. The aim of this study is to assess the accuracy of data reported in the UKRETS.
Methods
Retrospective audit of the accuracy of data in UKRETS for all thyroid operations performed by two surgeons from a single centre between 1/7/2016-30/6/2019. UKRETS data was compared with data extracted by an independent assessor from hospital Electronic Patient Records (EPR).
Results
204 patients were analysed. 91 (44.6%) had total thyroidectomy, 101 (49.5%) thyroid lobectomy and 34 (16.7%) neck dissection +/- thyroidectomy. 4080 data points from UKRETS were analysed. 94.0% (3835/4080) were accurate when compared to EPR. Pre-operative data was the least accurate 91.9% (937/1020) and peri-operative data was the most accurate 97.7% (997/1020). Post-operative and follow-up data had accuracies of 93.8% (957/1020) and 92.5% (944/1020) respectively. Date of operation was the most accurate, 99.0% (202/204) and date of discharge the least, 89.0% (182/204).
Conclusions
This study is the first external validation of data in the UKRETS and, while limited in number of surgeons / single centre, suggests that current data collection in UKRETS is accurate, particularly for peri-operative data. Further validation across multiple centres needs to be undertaken to confirm these findings.
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Affiliation(s)
| | | | - Ashley Hay
- Department of ENT, Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - Richard Adamson
- Department of ENT, Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - Iain Nixon
- Department of ENT, Head and Neck Surgery, NHS Lothian, Edinburgh, UK
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Rajan S, Aspinall S, Gray W, Day J, Lansdown M, Tolley N. Quality outcomes comparison of total thyroidectomy between UKRETS and HES databases. Br J Surg 2022. [DOI: 10.1093/bjs/znac057.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Hospital Episodes Statistics for England (HES) and UK Registry of Endocrine and Thyroid Surgery (UKRETS) are the largest databases on thyroidectomy within the UK. A validation of UKRETS data accuracy has never occurred. The purpose of this study was to compare quality outcomes in total thyroidectomy (TT) between the UKRETS and HES datasets.
Methods
A retrospective comparison study between UKRETS and HES for TT from April 2012–March 2018. Vocal cord palsy, hypocalcaemia, mortality & length of stay were the quality outcomes studied.
Results
The HES and UKRETS databases contained 23,025 and 11,242 patients respectively with UKRETS capturing 48.8% of HES data for TT. 18.8%(42/223) of surgeons performed ≥20 procedures/year in 54.3%(6110/11,242) of UKRETS procedures compared to only 9.7%(72/740) of surgeons from HES performing 44.6%(10,279/23,035) of all TTs. Median length of stay was significantly higher within in HES(2 days, IQR 1-3) versus UKRETS(1 day, IQR 1-2). 30.7%(7,071) of HES patients stayed for >2 days compared to 18.7%(1,837) within the UKRETS registry. Both databases reported a mortality of 0.1%. Post-operative hypocalcaemia was reported higher in UKRETS (21.7%) compared to HES (6.8%), p<0.0001. Rates of voice change were significantly higher in UKRETS (9.4%) compared to those in HES (1.3%), p<0.0001.
Conclusions
Surgeons contributing to UKRETS had a higher volume practice and shorter stay than those within HES. UKRETS appears to underreport the number of procedures conducted, with less low volume surgery captured. However, recording of hypocalcaemia and voice changes is mandatory in UKRETS, and HES appear to substantially under-report such complications.
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Affiliation(s)
- Sendhil Rajan
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - William Gray
- Getting It Right First-Time programme, NHS England and NHS Improvement, London, UK
| | - Jamie Day
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mark Lansdown
- Getting It Right First-Time programme, NHS England and NHS Improvement, London, UK
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Neil Tolley
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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9
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Nessa A, Aspinall S. 288 Impact of Trainee Surgeons Performing Thyroid Procedure on Patient Safety. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Impact of trainee surgeons performing thyroid procedure on patient safety
Aim
The primary aim was to evaluate the impact of trainee as the principal operator on patient safety in thyroid surgery.
Method
The data was extracted from a single consultant’s data from 2009 to 2020 in the British Association of Endocrine and Thyroid Surgeons (BAETS) National audit. Multivariable analysis of predictive factors (including trainee primary operator) for temporary and permanent hypocalcaemia was performed.
Results
There were 507 thyroid cases. After excluding cases with missing data in variables analysed 378 (74.5%) cases were analysed. Vocal cord palsy occurred in 5/378 (1.3%), postoperative bleeding 3/378 (0.8%), temporary hypocalcaemia 68/378 (18.0%) and permanent hypocalcaemia 20/378 (5.3%). Predictive factors analysed included hyperthyroidism 117/378 (31%), retrosternal goitre 33/378 (8%), reoperation, 43/378 (11%), total thyroidectomy 184/378 (49%), nodal dissection 21/378 (6%) and trainee principal operator 15/378 (4%). Multivariable analyses of temporary and permanent hypocalcaemia found only two variables significantly affected incidence of temporary hypocalcaemia were total thyroidectomy (OR 7.82, 95% CI 3.41-17.92, p < 0.001) and nodal dissection (OR 3.53, 95% CI 1.20-10.38, p = 0.02), and for permanent hypocalcaemia these were reoperation (OR 5.05, 95% CI 1.09-23.25, p = 0.04) and total thyroidectomy (OR 5.76, 95% CI 1.35-24.54, p = 0.018).
Conclusions
There was no evidence that trainee principal operator adversely affected the outcome of thyroidectomy; it is worth noting that only 4% of operations were done by trainees and so this study would support trainees undertaking more thyroidectomies as principal surgeon.
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Affiliation(s)
- A Nessa
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - S Aspinall
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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10
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Doran HE, Wiseman SM, Palazzo FF, Chadwick D, Aspinall S. UK National Registry Data supports safety of selective day case hemithyroidectomy by high volume thyroid surgeons. Br J Surg 2021; 108:e306. [PMID: 34115850 DOI: 10.1093/bjs/znab207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/13/2022]
Affiliation(s)
- H E Doran
- Department of Surgery, Salford Royal Hospital, UK
| | - S M Wiseman
- Department of Surgery, St. Paul's Hospital and University of British Columbia, Surgery, Vancouver, BC, Canada
| | - F F Palazzo
- Department of Surgery, Hammersmith Hospital, Imperial College Healthcare, UK
| | - D Chadwick
- Department of Surgery, Nottingham University Hospitals, UK
| | - S Aspinall
- Department of Surgery, Aberdeen Royal Infirmary, UK
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Gray WK, Aspinall S, Tolley N, Day J, Lansdown M. The volume and outcome relationship for thyroidectomy in England. Langenbecks Arch Surg 2021; 406:1999-2010. [PMID: 34106320 PMCID: PMC8188540 DOI: 10.1007/s00423-021-02223-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
Purpose The delivery of surgical care in England has seen a momentum towards centralisation within larger volume hospitals and surgical teams. The aim of this study was to investigate outcomes in England in relationship to hospital and surgeon annual volumes for total thyroidectomy. Methods Data were extracted from the Hospital Episodes Statistics (HES) database for England. A 6-year period (April 2012–March 2018 inclusive) for all adult admissions for thyroidectomy was used in the analysis. The primary outcome measure used was a length of hospital stay greater than 2 days or an emergency readmission within 30 days following surgery. This was used as a proxy for surgical complications. A multilevel modelling strategy was used to adjust for hierarchy and potentially confounding. Results Data for 22,823 total thyroidectomies across 144 hospital trusts were used for analysis. For total thyroidectomy, larger volume surgeons had reduced levels of post-surgical complications; length of stay > 2 and > 4 days; emergency readmission at 30 days; and hypoparathyroidism, vocal cord palsy, stridor, and tracheostomy at 1-year post-surgery. Larger hospital volume was associated with lower levels of emergency readmission at 30 days and hypoparathyroidism at 1 year. Conclusions There is significant correlation between surgeon volume and clinical outcome for total thyroidectomy. The relationship was approximately linear, and a low-volume threshold could not be defined. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02223-8.
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Affiliation(s)
- William K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, 1 Lower Marsh, London, SE1 7NT, UK.
| | - Sebastian Aspinall
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK.,Audit Lead, British Association of Endocrine and Thyroid Surgeons, London, UK
| | - Neil Tolley
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jamie Day
- Getting It Right First Time Programme, NHS England and NHS Improvement, 1 Lower Marsh, London, SE1 7NT, UK
| | - Mark Lansdown
- Getting It Right First Time Programme, NHS England and NHS Improvement, 1 Lower Marsh, London, SE1 7NT, UK.,St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Abdelhamid A, Aspinall S. Intraoperative nerve monitoring in thyroid surgery: analysis of United Kingdom registry of endocrine and thyroid surgery database. Br J Surg 2021; 108:182-187. [PMID: 33711146 DOI: 10.1093/bjs/znaa081] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/14/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Intraoperative nerve monitoring (IONM) is used increasingly in thyroid surgery to prevent recurrent laryngeal nerve (RLN) injury, despite lack of definitive evidence. This study analysed the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) to investigate whether IONM reduced the incidence of RLN injury. METHODS UKRETS data were extracted on 28 July 2018. Factors related to risk of RLN palsy, such as age, sex, retrosternal goitre, reoperation, use of energy devices, extent of surgery, nodal dissection and IONM, were analysed. Data with missing entries for these risk factors were excluded. Outcomes of patients who had preoperative and postoperative laryngoscopy were analysed. RESULTS RLN palsy occurred in 4.9 per cent of thyroidectomies. The palsy was temporary in 64.6 per cent and persistent in 35.4 per cent of patients. In multivariable analysis, IONM reduced the risk of RLN palsy (odds ratio (OR) 0.63, 95 per cent confidence interval (CI) 0.54 to 0.74, P < 0.001) and persistent nerve palsy (OR 0.47, 0.37 to 0.61, P < 0.001). Outpatient laryngoscopy was also associated with a reduced incidence of RLN palsy (OR 0.50, 0.37 to 0.67, P < 0.001). Bilateral RLN palsy occurred in 0.3 per cent. Reoperation (OR 12.30, 2.90 to 52.10, P = 0.001) and total thyroidectomy (OR 6.52, 1.50 to 27.80; P = 0.010) were significantly associated with bilateral RLN palsy. CONCLUSION The use of IONM is associated with a decreased risk of RLN injury in thyroidectomy. These results based on analysis of UKRETS data support the routine use of RLN monitoring in thyroid surgery.
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Affiliation(s)
- A Abdelhamid
- Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - S Aspinall
- Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
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Doran HE, Wiseman SM, Palazzo FF, Chadwick D, Aspinall S. Post-thyroidectomy bleeding: analysis of risk factors from a national registry. Br J Surg 2021; 108:851-857. [PMID: 33608709 DOI: 10.1093/bjs/znab015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/01/2020] [Accepted: 12/27/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Post-thyroidectomy haemorrhage occurs in 1-2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. METHODS The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. RESULTS Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. CONCLUSION The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.
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Affiliation(s)
- H E Doran
- Department of Surgery, Salford Royal Hospital, Salford, UK
| | - S M Wiseman
- Department of Surgery, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - F F Palazzo
- Department of Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - D Chadwick
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Aspinall
- Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
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Ishii H, Stechman MJ, Watkinson JC, Aspinall S, Kim DS. A Review of Parathyroid Surgery for Primary Hyperparathyroidism from the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS). World J Surg 2020; 45:782-789. [PMID: 33263777 PMCID: PMC7851004 DOI: 10.1007/s00268-020-05885-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The United Kingdom Registry of Endocrine and Thyroid Surgeons is a national database holding details on > 28,000 parathyroidectomies. METHODS An extract (2004-2017) of the database was analysed to investigate the reported efficacy, safety and use of intra-operative surgical adjuncts in targeted parathyroidectomy (tPTx) and bilateral neck exploration (BNE) for adult, first-time primary hyperparathyroidism (PHPT). RESULTS 50.9% of 21,738 cases underwent tPTx. Excellent short-term (median follow-up 35 days) post-operative normocalcaemia rates were reported overall (tPTx 96.6%, BNE 94.5%, p < 0.05) and in image-positive cases (tPTx 96.7%, BNE 96%, p < 0.05). Intra-operative PTH improved overall normocalcaemia rates (tPTx 97.8% vs 96.3%, BNE 95% vs 94.4%: both p < 0.05). Intra-operative nerve monitoring reduced vocal cord (VC) dysfunction in image-positive tPTx, but not in BNE (97.8% vs 93.2%, p < 0.05). Complications were higher following BNE (7.4% vs 3.8%, p < 0.05), especially hypocalcaemia (5.3% vs 2%, p < 0.05). There was no difference in rates of subjective dysphonia following tPTx or BNE (2.4% vs 2.3%, p > 0.05), nor any difference in VC dysfunction when formally examined (4.9% vs 4.1%, p > 0.05). CONCLUSIONS In image-positive, first time, adult PHPT cases, tPTx is as safe and effective as BNE, with both achieving excellent short-term results with minimal complications.
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Affiliation(s)
- H Ishii
- Department of ENT, Head & Neck Surgery, St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - M J Stechman
- Department of Endocrine Surgery, University Hospital Wales, Cardiff, UK
| | - J C Watkinson
- Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - S Aspinall
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - D S Kim
- Department of ENT, Head & Neck Surgery, St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
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Aspinall S, Hignett S, Godsiff S, Wheeler P, Fong D. A way to reduce manipulations under anaesthetic the STAK tool: a stretching device to treat arthrofibrosis following total knee replacement. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Calcitonin-negative medullary thyroid carcinoma is a rare, poorly understood primary neuroendocrine carcinoma of the thyroid characterised by classic medullary thyroid carcinoma morphology without raised serum calcitonin. A 24-year-old woman presented with a slow-growing, right-sided neck swelling. She underwent an ultrasound scan, cytopathological and histopathological examination, and tests for alternative diagnoses. The ultrasound showed a heterogeneous, hyperechoic nodule in the right thyroid lobe. Serum calcitonin was normal. Cytopathology and histopathology showed typical medullary thyroid carcinoma morphology but without calcitonin upon immunostaining and mRNA in situ hybridisation. A 'triple-negative' calcitonin-negative medullary thyroid carcinoma was diagnosed. A completion thyroidectomy with bilateral central lymph node dissection was performed. The patient remains well three-years post-surgery. When cytopathology suggests a medullary thyroid carcinoma, serum calcitonin, pro-calcitonin, carcinoembryonic antigen and calcitonin-gene-related peptide should be measured to identify cases of calcitonin-negative medullary thyroid carcinoma. They should also be measured post-treatment for monitoring purposes. This will aid future calcitonin-negative medullary thyroid carcinoma diagnoses and will inform prognostic stratification and influence treatment decisions.
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Affiliation(s)
- D C Murphy
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - S J Johnson
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - S Aspinall
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Bell A, Ali O, Robinson A, Aggarwal A, Blundell M, Townend A, Aspinall S. The role of pectoral nerve blocks in a day-case mastectomy service: A prospective cohort study. Ann Med Surg (Lond) 2019; 48:65-68. [PMID: 31719979 PMCID: PMC6838229 DOI: 10.1016/j.amsu.2019.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 01/13/2023] Open
Abstract
Background It is now recognised that the majority of breast surgery can be safely undertaken as day case procedures. We aimed to evaluate the effect of pectoral nerve (Pecs2) blocks on recovery parameters and day case rates in patients undergoing mastectomy for breast cancer. Methods A prospective cohort study was performed in a single NHS Foundation trust between 1st April 2014 and 31st December 2016. Visual analogue scale (VAS) pain scores (0-10) at 4 and 8 h, episodes of post-operative nausea ± vomiting (PONV), opioid use and day case outcome were compared between Pecs2 and no Pecs2 groups. Results 22 patients underwent general anaesthesia (GA) + Pecs2 block and 30 GA ± local anaesthetic infiltration.Mean pain scores were significantly lower in the Pecs2 (2.5) vs no Pecs2 (4.6) group at 4 h (p = 0.0132) and 8 h, Pecs2 (1.9) vs no Pecs2 (3.6) (p = 0.0038).Episodes of PONV requiring additional anti-emetic were lower and statistically significant in the Pecs2 group (2/22, 9%) than the no Pecs2 group (14/30, 46%), (p = 0.005).Additional opioid use was significantly lower in the Pecs2 group (4/22, 18%) than in the no Pecs2 group (14/30, 46%) (p = 0.0423).18 patients in the Pecs2 group were discharged the same day in contrast to just 3 patients in the no Pecs2 group. This was highly statistically significant (p = 0.0001). Conclusions Pecs2 blocks can significantly reduce post-operative pain, nausea and vomiting in patients undergoing mastectomy. Their use can enable units to achieve high day-case mastectomy rates.
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Affiliation(s)
- Ashleigh Bell
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
| | - Oroog Ali
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
| | - Amy Robinson
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
| | - Amitabh Aggarwal
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
| | - Michael Blundell
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
| | - Alice Townend
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
| | - Sebastian Aspinall
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
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Abstract
Introduction Hypoxic stress is a feature of rapidly growing thyroid tumours. Cancer progression is thought to be driven by a small population of tumour cells possessing stem cell properties. Hypoxia-inducible factors (HIFs) are important mediators of hypoxia. Both HIF-1alpha and HIF-2alpha have been reported to be expressed in thyroid cancers. There is growing evidence that the HIF pathway plays a significant role in the maintenance of thyroid cancer stem cells (CSC). Methodology We have isolated thyroid CSC from a papillary thyroid cancer-derived cell line (BCPAP) and an anaplastic thyroid cancer-derived cell line (SW1736) as side population (SP) cells (a putative stem cell population) and treated them with cobalt chloride (II) to induce hypoxia. Results and discussion We observed an increase in the SP of cells within the thyroid cancer cell lines following induction of hypoxia.
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Affiliation(s)
- K Mahkamova
- Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE1 3BZ, UK
| | - N Latar
- Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE1 3BZ, UK
| | - S Aspinall
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - A Meeson
- Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE1 3BZ, UK.
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Aspinall S, Conradie JD, Fourie PJ, Beyers M. Radioiodination of Murine Anti-Alphafoetoprotein E.9 Monoclonal Antibody and its F(ab’)2 Fragment for the Diagnosis of Hepatocellular Carcinoma. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The high incidence of hepatocellular carcinoma amongst certain population groups of Southern Africa made feasible the investigation of a radiolabeled monoclonal anti-alphafoetoprotein as a radioimmunodiagnostic agent for this disease. This paper reports the preclinical trials with monoclonal anti-alphafoetoprotein E.9 (anti-AFP) and its F(ab’)2 fragment after radiolabelling with 131l. Various radioiodinations were tried. The best results were obtained with the lodogen and Bolton-Hunter methods.1311 from only one of the sources tested gave an 131 l-labelled anti-AFP with meaningful immunoreactivity. It was shown by means of gamma-camera scans and monitoring of radioactivity in individual organs that 131l-anti-AFP and the 131l-anti-AFP F(ab’)2 fragments did not accumulate abnormally in any organ(s) in healthy animals. The correlation in healthy mice of the biodistribution of 125l human IgG to 131 l-anti-AFP, and 125l human IgG to 131l-F(ab’)2 was good. Human hepatoma xenografts in athymic mice showed uptake of131 l-anti-AFP and the 131l-F(ab’)2 fragment. The uptake of 131l-F(ab’)2 was improved by liver background subtraction. There was correlation between circulatory alphafoetoprotein concentrations and tumour uptake of 131l-F(ab’)2 in tumour-bearing athymic mice and a definite relationship was found between tumour size and radiolabelled antibody and the F(ab’)2 fragment. After the biological action of the131 l-anti-AFP and the 131l-F(ab’)2 fragment was known, sterile pyrogen-free consignments were supplied for clinical trials in humans on a regular basis.
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Jalini L, Aspinall S, Kalbassi R, Cain H, Hemming D, Browell D, Lennard T. Androgen receptor expression, impact on survival and its correlation to clinico-pathological factors in breast cancer. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.01.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
As cross-sectional abdominal imaging is used increasingly, adrenal incidentaloma (AI) are being found frequently and present a clinical dilemma. The vast majority are benign and non-functioning, but a minority represent incidentally found functional or malignant tumours. In this review we summarise the current clinical, biochemical and radiological investigation of AI and discuss recent advances that differentiate clinically inconsequential lesions from functional and/or malignant AI. Areas covered: Prevalence, natural history, biochemical and radiological assessment, indications for surgery and surgical provision. Expert commentary: Well established work-up of AI usually enables benign, non-functioning lesions to be differentiated from functioning and/or malignant AI. In indeterminate lesions recent advances in work-up such as urine steroid profiles measured by gas chromatography /mass spectrometry and functional imaging with 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) in addition to standard investigations have improved characterisation of these lesions. The management of AI showing mild autonomous hypercortisolism without overt features of Cushing's syndrome remains controversial and is discussed in this review.
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Affiliation(s)
- Iain Mackay
- a Department of Surgery , Royal Victoria Infirmary , Newcastle upon Tyne , UK
| | - Sebastian Aspinall
- b Department of Surgery , Northumbria Healthcare NHS Foundation Trust , North Shields , UK
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Mahkamova K, Latar N, Mallini P, Meeson A, Aspinall S. 5. Stem cells in undifferentiated, recurrent and metastatic thyroid cancers: A new direction for development of targeted therapies. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.08.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Johnson SJ, Hobday C, Aspinall S. 24. Central review of thyroid cytology for the MDTM – Does it improve accuracy? Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.08.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pieri A, Cain H, Aspinall S. Abstract P2-01-14: Pre-operative axillary staging results in over-treatment in some breast cancer patients. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p2-01-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Following a diagnosis of breast cancer, pre-operative ultrasound staging of the axilla is recommended. Patients found to have metastatic disease on biopsy or FNA can proceed directly to axillary clearance (ALNC) at the time of their breast tumour excision. However, although ultrasound staging is a sensitive test to detect axillary disease, it does not differentiate between low and high volume nodal metastasis. Recent evidence suggests that, in selected patients with low volume axillary disease following SLNB, completion ALNC may be safely omitted. This has been reflected in the recently updated ASCO guidelines. In light of this current trend towards axillary conservation, some patients undergoing ALNC after positive axillary staging may be over-treated.
The aims of this study is to establish the nodal burden of patients undergoing ALNC following positive axillary staging and to compare the nodal burden of those patients with those undergoing completion ALNC after a positive SLNB.
Methods
Data was collected prospectively over 12 months from nine hospitals within the North of England Cancer Network. Age, tumour characteristics, breast operation, axillary staging results, axillary operation(s) and nodal results were recorded.
Results
A total of 1010 patients with breast cancer underwent pre-operative axillary staging. 215 patients (21%) had an ALNC. Of these, 115 (53%) cases underwent a primary ALNC after positive staging. The remaining 100 (47%) patients had a completion ALNC following a positive SLNB. The nodal burden for patients undergoing ALNC is shown in the table below:
Total number of positive nodesALNC after positive stagingALNC after positive SLNB n patients% patientsn patients% patients087001322847472131124243121011114111044≥539341414Totals115 100
Analysis of the data revealed that tumour size was a significant predictor of low volume axillary disease (i.e. <3 nodes positive) [p=0.02, Mann-Whitney test].
Conclusion
In this study, 46% of patients undergoing ALNC after positive staging had low volume disease (2 or less positive nodes). In the context of recent evidence if these patients had undergone a SLNB following the positive pre-operative staging they may have avoided a completion ALNC.
This study demonstrates tumour size to be a significant predictor of low volume axillary disease and thus may be an important factor to consider alongside pre-operative staging when selecting patients who may be better managed by a SLNB rather than proceeding directly to ALNC.
Citation Format: Andrew Pieri, Henry Cain, Sebastian Aspinall. Pre-operative axillary staging results in over-treatment in some breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-01-14.
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Ward A, Light A, Truran P, Aspinall S. Reprint of: Thyroid ultrasound - The time has come for specialist radiology. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Pieri A, Aspinall S, Cain H. 209. Pre-operative axillary staging results in overtreatment in some breast cancer patients. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
INTRODUCTION Adrenal incidentalomas have become a common clinical dilemma with the increasing use and resolution of cross sectional imaging modalities. OBJECTIVES This retrospective observational study examined the management of adrenal incidentalomas in district general hospitals in Northumbria and adherence to current guidelines. MATERIALS AND METHODS We searched 4028 abdominal CT scans performed in Northumbria between 1 January and 31 December 2010. All patients with an incidental adrenal lesion were identified and their clinical records reviewed. RESULTS 75 patients with adrenal incidentalomas were identified. Of these, only 13 (17%) were referred for specialist review with a further two patients undergoing additional evaluation by the primary medical team; 80% received no biochemical investigation or follow-up. Comorbidity may have affected the decision in a proportion, but 36 of 62 patients (58%) had no comorbidities precluding additional evaluation. In contrast, all patients reviewed by an endocrine specialist were appropriately investigated and managed, the majority conservatively, with three requiring adrenalectomy for phaeochromocytoma or cortisol secreting adenomas. In the patients with an incidentaloma, comorbidities which may be attributable to autonomous adrenal cortisol or aldosterone release were higher than regional averages, suggesting possible undiagnosed functional tumours. CONCLUSIONS The management of adrenal incidentalomas in British district general hospitals in Northumbria shows poor adherence to guidelines. Adherence was significantly better in those patients managed by an endocrine specialist. We suggest a pathway for the management and referral process.
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Affiliation(s)
- Emily Davenport
- Department of Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Pitsien Lang Ping Nam
- Department of Accident and Emergency, Wansbeck General Hospital, Northumbria Healthcare NHS Trust, Newcastle, UK
| | - Michael Wilson
- Department of General Surgery, Perth Royal Infirmary, Tayside University Hospital NHS Trust, Perth, UK
| | - Alastair Reid
- Department of General Surgery, Northumbria Healthcare NHS Trust, North Tyneside, UK
| | - Sebastian Aspinall
- Endocrine and General Surgeon, Department of General Surgery, North Tyneside Hospital, Northumbria Healthcare NHS Trust, Northumberland, UK
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Aspinall S. Author's Response. Ann R Coll Surg Engl 2012. [DOI: 10.1308/003588412x13171221591574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Townend A, Wilson M, Allan S, Moir J, Serra P, Aspinall S. Delayed-Immediate Breast Reconstruction: Our Experience. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.02.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bichel C, Aspinall S, Burke M, Cole R, Osborne C, Davies S. A local government resource to create supportive environments for physical activity and healthy eating. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Green M, Aspinall S, Kollias J. Safety and efficacy of contra-lateral breast reduction for women with mammary hypertrophy undergoing mastectomy for breast cancer. Breast 2009; 18:276-8. [PMID: 19850479 DOI: 10.1016/j.breast.2009.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 07/18/2009] [Accepted: 09/13/2009] [Indexed: 11/25/2022] Open
Abstract
Women with mammary hypertrophy undergoing mastectomy for breast cancer suffer disability because of disproportionate asymmetry. The case notes of all women with mammary hypertrophy undergoing mastectomy and immediate contra-lateral reduction mammaplasty for primary breast cancer from February 2001 to December 2008 were reviewed. Thirty-three women were identified of whom twenty-seven underwent inferior pedicle reduction mammaplasty and six inferior dermoglandular pedicle reduction with free nipple graft. The duration of surgery ranged from 75 to 146 (median 110) minutes. Between 475 and 2350 (median 1090) grams of breast tissue was excised from the contra-lateral breast. No immediate or delayed complications were observed and there were no delays in commencing adjuvant therapy. Immediate contra-lateral breast reduction in women with mammary hypertrophy undergoing mastectomy for breast cancer is safe and effective means of reducing the physical, psychological and cosmetic problems associated with unilateral mammary hypertrophy following mastectomy.
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Affiliation(s)
- Michael Green
- Breast, Endocrine and Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, Australia
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Leonello D, Aspinall S, Kollias J. Laparoscopic spleen extraction--a simple technique. Ann R Coll Surg Engl 2009. [PMID: 19622262 DOI: 10.1308/003588409x428531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Domenic Leonello
- Department of Breast, Endocrine and Surgical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Affiliation(s)
- Domenic Leonello
- Department of Breast, Endocrine and Surgical Oncology, Royal Adelaide Hospital Adelaide, South Australia, Australia
| | - Sebastian Aspinall
- Department of Breast, Endocrine and Surgical Oncology, Royal Adelaide Hospital Adelaide, South Australia, Australia
| | - James Kollias
- Department of Breast, Endocrine and Surgical Oncology, Royal Adelaide Hospital Adelaide, South Australia, Australia
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Abstract
INTRODUCTION Safe and effective haemostasis in surgery is clearly essential, and in the neck where risks of airway compromise are also present any new technology that purports to offer advantages must be rigorously evaluated. We describe our experience with the use of the Harmonic Scalpel [Ethicon UK] in thyroidectomy. PATIENTS AND METHODS A retrospective clinical review of 183 patients undergoing hemi or total thyroidectomies from 12 months prior to using the harmonic scalpel (2003; n = 77) and 12 months 'beyond the learning curve' (2006; n = 106). RESULTS The results demonstrate that, once past the learning curve, the use of the harmonic scalpel during thyroidectomy significantly reduces operative time and postoperative hypocalcaemia, and is as safe as conventional surgery with regard to voice change and bleeding. CONCLUSIONS The harmonic scalpel is as safe as conventional methods of haemostasis and operations using this technique are quicker once the need to have repetitive 'clip, cut and tie' routines is avoided.
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Affiliation(s)
- E Foreman
- Department of Endocrine Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Aspinall S, Shilton T, Oldenburg B, Bauman A. 272 The contribution of Jump Rope for Heart to the physical activity levels of Australian schoolchildren. J Sci Med Sport 2005. [DOI: 10.1016/s1440-2440(17)30768-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mphahlele MJ, Burnett RJ, Kyaw T, Schoeman HS, Aspinall S. Immunogenicity and safety of yeast-derived recombinant hepatitis B vaccine (Heberbiovac HB) in South African children. S Afr Med J 2004; 94:280-1. [PMID: 15150941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
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Mphahlele MJ, Tshatsinde EA, Burnett RJ, Aspinall S. Protective efficacy and antibody follow-up of hepatitis B vaccine within the South African expanded programme on immunisation. S Afr Med J 2002; 92:612-3. [PMID: 12244619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
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39
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Kedda MA, Kramvis A, Kew MC, Lecatsas G, Paterson AC, Aspinall S, Stark JH, De Klerk WA, Gridelli B. Susceptibility of chacma baboons (Papio ursinus orientalis) to infection by hepatitis B virus. Transplantation 2000; 69:1429-34. [PMID: 10798766 DOI: 10.1097/00007890-200004150-00037] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because baboons are being considered as a source of xenografts for human liver transplantation in patients with hepatitis B virus- (HBV) induced cirrhosis to forestall infection of the graft by the virus, we undertook a study to ascertain if baboons are resistant to HBV infection. METHODS Six chacma baboons were inoculated with serum containing HBV and were followed for 52 weeks to detect transmission of infection. RESULTS Anti-HBc was detected in the serum of four baboons 16 weeks after inoculation. Virions, small spherical particles, and tubular forms were seen at this time in the serum of the one baboon studied by transmission electron microscopy. HBV DNA was detected by polymerase chain reaction in the serum of the same four baboons throughout the period of follow-up, as well as in liver tissue obtained after 52 weeks. The specificity of the DNA was confirmed by Southern hybridization. Nucleotide sequences showed complete sequence identity between the HBV DNA in each of the baboon sera and one of the two HBV genotypes inoculated. Serum transaminase levels tested at 4-weekly intervals were always normal and histological examination of liver tissue after 52 weeks showed no evidence of chronic hepatitis. Examination of squash preparations of liver tissue by electron microscopy in one baboon revealed core-like particles. CONCLUSIONS Chacma baboons are susceptible to HBV infection and appear to develop a chronic carrier state. The use of xenografts from baboons should preferably be avoided, but if they are used again for HBV-infected patients it would be prudent to treat the patients as if they had received an organ from a human donor.
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Affiliation(s)
- M A Kedda
- Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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40
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Abstract
Virus-like particles (VLPs) of the high-risk human papillomavirus (HPV) types 16, 18, 31, 33, and 45 were used as antigen in enzyme-linked immunosorbent assay (ELISA) to determine the prevalence of serum IgG in a group of San people originally from Namibia, now residing in South Africa. The San children had low seroprevalence to all VLP types, but 26/115 (22.6%) of the children were seropositive to at least 1 VLP type. Among the adults, seroprevalence was significantly higher. The seroprevalence of antibodies in 101 San women to VLP-16 was 16.8%, VLP-18 18.8%, VLP-31 12.9%, VLP-33 17.8%, and VLP-45 22.8%. Five of the 11 men were seropositive: 2 for VLP-31, 1 for VLP-18, 1 for VLP-33, and 1 for VLP-45. Seroreactivity appeared to be type specific, except possibly to VLP-18 and -45. Of the adults, 50.5% were seropositive to at least 1 VLP type and 24.8% were seropositive to >1 VLP type. From this study, it is concluded that the San people are exposed to HPV-16, -18, -31, -33, and -45, with antibodies to VLP-45 being the most prevalent.
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Affiliation(s)
- D Marais
- Department of Medical Microbiology, UCT Medical School, Cape Town, South Africa
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Abstract
AIM To investigate the age related prevalence of hepatitis G virus (HGV) infection and its mode of transmission in relation to hepatitis B (HBV) and C (HCV) co-infection in South African blacks. METHODS Reverse transcriptase polymerase chain reaction was performed to detect active infection, using primers for the 5'-NCR, NS5a, and NS3 regions. Antibodies to HGV envelope-2 protein (anti-E2), which measures past infection, were also sought. RESULTS The overall prevalence of active infection was 116/580 (20%). A higher prevalence was noted in HBsAg carriers (28/106; 26.4%) and HCV positive subjects (25/82; 30.5%). In contrast to developed countries, active and past infection was seen in 12.9% and 12.1% of the general population, respectively (subjects negative for HBsAg and anti-HCV markers and with normal alanine aminotransferase values), with a total prevalence of 21.1% (52/248). Viraemia and anti-E2 were almost mutually exclusive. The distribution of viraemia by age was: < or = 15 years, 20/223 (9.0%); 16-35 years, 42/147 (28.6%); > or = 36 years, 37/151 (24.5%), with a significant difference (p = 0.001) in age related prevalence. A similar trend was observed for the prevalence of past infection in the general population. CONCLUSIONS HGV infection begins in childhood and increases with age in South Africa, but transmission is largely independent of HBV and HCV. No association was found between HGV viraemia and hepatitis, or with co-infection with either HBV or HCV.
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Affiliation(s)
- M J Mphahlele
- Department of Virology, Medical University of Southern Africa, Pretoria, South Africa
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Abstract
STATEMENT OF PROBLEM Hepatitis B infection (HBV) is a significant hazard in the dental environment because the virus may be transmitted through contaminated dental instruments. PURPOSE This study determined whether cold disinfectants can inactivate HBV DNA and HBV surface antigens on diamond burs contaminated with HBV and whether ultrasonication can increase the antiviral properties of these agents. MATERIAL AND METHODS Sterile dental diamond burs were contaminated with serum from a patient who tested positive for HBV surface antigen and hepatitis B viral DNA. The burs were air dried and placed in solutions containing either Cidex, Asepsys, TBS, Rotagerm, Virkon disinfectants, or a control phosphate buffered saline. Burs were divided into 2 groups and disinfected for 15 minutes. The first group was ultrasonicated; the second group was not ultrasonicated during disinfection. All the burs were transferred to phosphate buffered saline and ultrasonicated to remove any remaining viral particles. The ultrasonicate was tested for the presence of HBV surface antigen with a microparticle enzyme immunoassay and for hepatitis B viral DNA with a chemiluminescent molecular hybridization assay. RESULTS TBS did not require ultrasonication to inactivate viral DNA and surface antigen. Rotagerm and Virkon inactivated surface antigen and viral DNA only with ultrasonication. Cidex and Asepsys inactivated viral DNA but not surface antigen with ultrasonication. CONCLUSION The chlorine containing compound TBS was the most active disinfectant tested and did not require ultrasonication to destroy HBV. The remaining disinfectants should be used with ultrasonication to inactivate HBV.
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Affiliation(s)
- A P Leontiou
- University of the Witwatersrand, Johannesburg, South Africa
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Kamper AM, Van Der Merwe CF, Aspinall S. Chronic hepatitis B and neurogenic muscle disease: case report. East Afr Med J 1998; 75:667-8. [PMID: 10065183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A 17 year-old boy with chronic hepatitis B who developed left-sided muscle wasting is reported. When other possible known diseases as the cause of the neurogenic muscle disease were excluded it was hypothesised that there was a relation between the chronic hepatitis B infection and the neurogenic muscle disease. An immunopathogenesis could be explained by the presence of HBsAg in the cerebral spinal fluid.
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Affiliation(s)
- A M Kamper
- Department of Gastroenterology, Medical University of Southern Africa, Medunsa, South Africa
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44
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Aspinall S, Kocks DJ. Immunogenicity of a low-cost hepatitis B vaccine in the South African Expanded Programme on Immunisation. S Afr Med J 1998; 88:36-9. [PMID: 9539933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A low-cost, 'flash' heat-inactivated hepatitis B vaccine with enhanced immunogenicity allowing for a relatively low dose (Hepaccine B; Cheil Foods and Chemicals, Korea) was introduced into the South African Expanded Programme on Immunisation during 1995 to immunise infants against hepatitis B. To determine the seroresponse of this vaccine in South Africa, a country with a high hepatitis B virus (HBV) prevalence, a field trial was conducted in a rural health clinic. METHODS The immunogenicity of Hepaccine B, containing 1.5 micrograms/0.5 ml, was studied in 186 black infants attending the Soshanguve III clinic, north-west of Pretoria. Infants receiving three consecutive doses in the anterolateral thigh at 6, 10 and 14 weeks were monitored. The doses were administered concurrently with their routine oral polio vaccine (OPV) and diphtheria, pertussis and tetanus (DPT) immunisations. Vaccine side-effects were recorded. Blood specimens were collected 3 months after the final vaccination. Sera were tested for antibodies to hepatitis B surface antigen (anti-HBs) by IMx AUSAB (Abbott Laboratories, USA). Levels of anti-HBs were determined by comparison with standard reference preparations and expressed in mlU/ml. RESULTS Side-effects of the vaccine were minor, with limited local reaction at the site of administration. The anti-HBs seroconversion rate was 93.0%, based on a titre of > or = 10 mlU/ml with a geometric mean titre of 257.58 mlU/ml. CONCLUSIONS Administration of 1.5 micrograms dose of Hepaccine B at 6, 10 and 14 weeks is safe and highly immunogenic in black South African infants, and this vaccine is suitable for use in countries with high HBV prevalences such as in Africa. The use of an economical hepatitis B vaccine would greatly facilitate the prevention of hepatitis B in these countries.
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Affiliation(s)
- S Aspinall
- Department of Virology, Medical University of Southern Africa, Medunsa
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45
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Kocks DJ, Aspinall S, Seema MT. Hepatitis B immunisation for adults and health care workers in South Africa. S Afr Med J 1997; 87:1388-9. [PMID: 9472259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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46
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Sithebe NP, Aspinall S, Smuts H. Molecular epidemiology of hepatitis C virus infection at Ga-Rankuwa Hospital. S Afr Med J 1996; 86:1543-5. [PMID: 8998224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Different hepatitis C virus (HCV) genotypes may be associated with viral load, severity of liver disease, hepatocellular carcinoma, geographical location and sensitivity to interferon. In this study the prevalence of HCV-RNA and distribution of HCV genotypes was investigated in anti-HCV-positive patients admitted to Ga-Rankuwa Hospital during 1994 and 1995. One hundred and forty-nine sera from three groups of anti-HCV-positive patients (N = 78) were analysed. These included: (i) patients with various liver diseases; (ii) patients admitted to the renal unit; and (iii) a miscellaneous group of patients for whom HCV antibody screening was requested. Twenty-six patients (33%) tested positive for viral RNA. Restriction fragment length polymorphism (RFLP) analysis of these patients showed that HCV genotypes 1, 2 and 5 were present. Type 2 (35%) was the dominant genotype in the region served by Ga-Rankuwa Hospital. In a large proportion of viral RNA-positive patients (27%), the polymerase chain reaction product could not be digested with one of the sets of enzymes, and therefore could not be classified into genotypes 1 to 6. Further studies are now in progress to enhance our current knowledge of the epidemiology of HCV infection.
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Affiliation(s)
- N P Sithebe
- Department of Virology, Medical University of Southern Africa
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47
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Aspinall S. Taking research forward at MEDUNSA. Priority-setting, research infrastructure and capacity development. S Afr Med J 1996; 86:1527. [PMID: 8998218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Voigt MD, Bird AR, Kirsch RE, Kew MC, Aspinall S, Sims J. National strategy for the prevention and management of transfusion-associated hepatitis. S Afr Med J 1996; 86:245-51. [PMID: 8658294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- M D Voigt
- MRC/UCT Liver Research Centre, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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Connell C, Aspinall S, Corkill J. Sputum and serum pharmacokinetics of loracarbef (LY163892) in patients with bronchial sepsis. J Antimicrob Chemother 1995; 36:446-7. [PMID: 8522479 DOI: 10.1093/jac/36.2.446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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50
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Gaobepe M, Aspinall S, Bos P. Hepatitis B viral markers in Bushmen at Schmidtsdrift, South Africa: baseline studies for immunisation. East Afr Med J 1995; 72:421-3. [PMID: 7498022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In an effort to control hepatitis B virus (HBV), the prevalence rates of the virus need to be ascertained in different regions or populations. As a baseline for a hepatitis B immunisation programme, the seroprevalence of HBV markers was determined in 400 San Bushmen from a community who were translocated from Northern Namibia to South Africa. HBsAg was detected in 6.8% while 57.0% showed one or more markers of HBV infection. The balance of the population (43.0%) showed no evidence of previous exposure to HBV. The HBV exposure rate of 57.0% is intermediate to high with reference to internationally reported figures and protection of seronegative individuals through immunisation is recommended. Individuals without possible natural immunity against HBV such as those with anti-HBc or anti-HBs as a sole marker may provide insight into the circulation of HBV mutants in this community, since these sole markers could be seroconversion in response to a mutant HBV strain.
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Affiliation(s)
- M Gaobepe
- Department of Virology, Medical University of Southern Africa, Medunsa
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